Xenograft iterposition in female urethral diverticulum surgery.

OBJECTIVE: To describe the use collagen xenograft as adjuvant therapy in the surgical treatment of female urethral diverticulum (FUD) and to perform a bibliographic review. METHODS: We performed a surgical approach to remove the diverticulum and repair the remaining dead space with a porcine collagen mesh to avoid fistulas. Monitoring is done by MRI. RESULTS: After two years of follow up the patient improved considerably, disappearing the previous symptoms. Follow-up MRI showed no abnormality: There was no inflammatory reaction or encapsulation of any kind. CONCLUSIONS: We recognize that the flap or the use of a xenograft are not always necessary, but due to its technical simplicity and effectiveness, it is an important tool for diverticulum surgery. However, more experience is needed to assess the appropriateness of this method.

Interposición de xenoinjerto en cirugía de Divertículo uretral femenino / Xenograft iterposition in female urethral diverticulum surgery

OBJETIVO: Describir el uso de un xenoinjerto de colágeno como medida adyuvante en el tratamiento quirúrgico del divertículo uretral femenino (FUD) y realizar una revisión bibliográfica. MÉTODOS: Mediante un abordaje quirúrgico se realiza la excisión del divertículo y se repara el espacio muerto creado con una malla de colágeno porcino para evitar posibles fístulas. El seguimiento se realiza mediante RM. RESULTADOS: A los dos años de seguimiento, la paciente mejoró notablemente, desapareciendo los síntomas que presentaba antes del tratamiento. En el seguimiento mediante la RM no se demostró ninguna anormalidad: no se observó ni encapsulación ni reacción inflamatoria de ningún tipo. CONCLUSIONES: Reconocemos que el colgajo o la interposición de un xenoinjerto no siempre es necesario, pero debido a su simplicidad técnica y eficacia, es una herramienta importante para la cirugía de divertículo(AU)

OBJECTIVE: To describe the use collagen xenograft as adjuvant therapy in the surgical treatment of female urethral diverticulum (FUD) and to perform a bibliographic review. METHODS: We performed a surgical approach to remove the diverticulum and repair the remaining dead space with a porcine collagen mesh to avoid fistulas. Monitoring is done by MRI. RESULTS: After two years of follow up the patient improved considerably, disappearing the previous symptoms. Follow-up MRI showed no abnormality: There was no inflammatory reaction or encapsulation of any kind. CONCLUSIONS: We recognize that the flap or the use of a xenograft are not always necessary, but due to its technical simplicity and effectiveness, it is an important tool for diverticulum surgery. However, more experience is needed to assess the appropriateness of this method(AU)

Respuesta y supervivencia libre de progresión en tumores vesicales en estadios T2-T4 tratados con tratamiento trimodal de conservación vesical / Response and Progression-Free Survival in T2 to T4 bladder tumors treated with trimodality therapy with bladder preservation

Objetivo: Evaluar la respuesta y la supervivencia libre de progresión (SLP) en pacientes diagnosticados de carcinoma vesical infiltrante tratados con RTU-quimioterapia-radioterapia y compararlos con una serie no aleatorizada de pacientes tratados con cistectomía radical. Material y métodos: Análisis retrospectivo de 43 pacientes con carcinoma vesical infiltrante tratados entre 1994–2007 con dos pautas de conservación vesical y estudio comparativo con pacientes sometidos a cistectomía radical (145 casos) en el mismo periodo. Las variables pronósticas para estudio fueron estadio y grado clínico, presencia o no de hidronefrosis, tratamiento quimioterapéutico recibido, dosis de radioterapia y alteraciones en p53 y Ki67. Resultados: La media y la mediana de los pacientes sometidos a conservación vesical fueron de 51 y de 39 meses, respectivamente. El 72% de los pacientes con conservación vesical obtuvo respuesta completa (RC) al finalizar el tratamiento. Solo la hidronefrosis tuvo influencia pronóstica (OR: 7,3; p=0,02). Al final del estudio, el 74% de los que obtuvieron RC mantenía la respuesta. Ninguna de las variables analizadas fueron predictoras del mantenimiento de la respuesta. La SLP en el grupo fue del 69±7 y del 61±7% a 3 y a 5 años. La dosis de radioterapia >60Gy (OR: 6,1; p=0,001) y la ausencia de hidronefrosis (OR 7,5; p=0,02) fueron las únicas variables influyentes. La SLP del grupo con RC fue del 80±7 y del 58±10% a 3 y a 5 años. Al concluir el estudio, 23/43 (53,5%) conservaban la vejiga y estaban libres de enfermedad. Se realizaron 145 cistectomías radicales a pacientes diagnosticados de carcinoma vesical infiltrante. La media y la mediana de seguimiento de este grupo fueron de 29 y 18 meses, respectivamente. El análisis estadístico reflejó que los pacientes que se habían sometido a conservación vesical presentaban únicamente peor estadio clínico que los pacientes sometidos a cistectomía radical (p=0,17).La SLP a 3 y a 5 años de los pacientes sometidos a cistectomía radical fue del 72±5 y del 63±7%, no evidenciando diferencias estadísticamente significativas (p=0,83) con respecto a los pacientes sometidos a pauta de conservación vesical. Conclusiones: Los pacientes sometidos a conservación vesical obtienen una supervivencia similar a la de los pacientes a los que se les ha realizado cistectomía radical. La dosis de radioterapia >60Gy y la ausencia de hidronefrosis son factores de influencia independiente en la SLP (AU)

Objective: To evaluate the response and the free-survival progression in pacients diagnosed of invasive bladder cancer who have been treated with transurethral resection, chemotherapy and radiotherapy. This multimodal treatment is compared with a not random serie of patients treated by radical cistectomy. Material and methods: Retrospective analysis of 43 cases of invasive bladder cancer treated with two schemes of bladder preservation between 1994–2007. They are compared with 145 cases treated with radical cistectomy in the same period of time. Pronostic variables included in the study are clinical stage, grade of differentiation, presence of ureteral obstruction, chemotherapy modality, radiotherapy doses and p53 and ki-67 expression. Results: Mean and median time are 51 and 39 months in patients with multimodal treatment. Complete response is achieved in 72% of cases treated with bladder preservation. Ureteral obstruction is a prognostic factor (OR: 7,3;p:0,02). 72% patients with complete response mantain it at the end of the study. None of analyzed variables are predictors of maintenance of the response. Survival rates with a intact bladder were 69±7% and 61±7% at three and five years. Radiotherapy doses greater than 60Gy (OR: 6,1; p<0,001) and the absence of ureteral obstruction (OR: 7,5; p<0,002) were pronostic variables. Free-survival in patients with complete response was 80±7% and 58±10% at three and five years. At the end of the study, 53,5% of patients had a intact bladder and free-disease. In the same period of time, 145 radical cistectomies were performed due to muscle invasive bladder cancer. Mean and median time in this group were 29 and 18 months respectively. Stadistical analysis reveals a worse clinical stage in the group of patients treated with multimodal treatment (p:0.01). Free-survival was 72±5% and 63±7% at 3 and 5 years in the group of radical cistectomies. There was not stadistical significant differences between cistectomies and bladder preservation. Conclusions: Patients treated with bladder preservation have a free-survival similar to those treted with radical cistectomy. Radiotherapy doses greater than 60Gy and absence of ureteral obstruction were free-survival prognostic variables (AU)

Nefrectomía parcial laparoscópica. Análisis de los primeros 30 casos de nuestra serie y revisión de la literatura / Laparoscopic Partial Nephrectomy. Analysis of first 30 cases of our series and review of the literature

Objectivo: Nuestro objetivo es analizar los resultados quirúrgicos y clínicopatológicos de nuestra serie de 30 Nefrectomías Parciales Laparoscópicas (NPL) realizadas de forma consecutiva y correlacionar los resultados con la literatura. Material y métodos: Se trata de una serie de casos, con 30 pacientes (20 varones y 10 mujeres) operados entre 2006 y 2008. Hemos valorado los factores clínico-patológicos y las complicaciones. La media y mediana de seguimiento fue de 25 y 5 meses. Resultados: Los tumores resecados tenían un tamaño medio de 2,4 cm. El 60% de los tumores fueron malignos. El estadio patológico fue pT1 en el 100% de los casos (47% grado I, 53% grado II de Furhman).Obtuvimos márgenes quirúrgicos positivos en 3 casos, reconvirtiéndolos a cirugía abierta. El sangrado intraoperatorio fue de 74,66 cc (±35,7 DE) y 70 cc de media y mediana. La media de tiempo quirúrgico fue de 214,4min (±69 DE) y tiempo de isquemia de 31,3min (±13,8 DE). Conclusiones: Nuestros resultados son superponibles a los reflejados en la literatura, exceptuando los márgenes positivos y reconversiones, atribuibles a la curva de aprendizaje (AU)

Objective: Our goal is to analyze the surgical and clinicopathological results of our first 30 laparoscopic partial nephrectomies (LPN) performed consecutively and correlate the results with the literature. Material and methods: This is a cases series, with 30 patients (20 men and 10 women) operated between 2006 and 2008. We assessed the clinicopathological factors and complications. The mean and median follow-up was 25 and 5 months. Results: Resected tumors had an average size of 2.4 cm. 60% of the tumors were malignant. The pathological stage was pT1 in 100% of cases (47% grade I, 53% Fuhrman grade II).Surgical margins were positive in 3 cases, switching to open surgery. Intraoperative bleeding was 74.66 cc (35.7±SD) and 70 cc of mean and median. The mean operative time was 214.4min (±69) and ischemia time of 31.3min (±13.8). Conclusions: Our results are similar to those reported in the literature, except for positive margins and conversion attributable to the learning curve (AU)

[Response and progression-free survival in T2 to T4 bladder tumors treated with trimodality therapy with bladder preservation]. / Respuesta y supervivencia libre de progresión en tumores vesicales en estadios T2-T4 tratados con tratamiento trimodal de conservación vesical.

OBJECTIVE: To evaluate the response and the free-survival progression in patients diagnosed of invasive bladder cancer who have been treated with transurethral resection, chemotherapy and radiotherapy. This multimodal treatment is compared with a not random serie of patients treated by radical cistectomy. MATERIAL AND METHODS: Retrospective analysis of 43 cases of invasive bladder cancer treated with two schemes of bladder preservation between 1994-2007. They are compared with 145 cases treated with radical cistectomy in the same period of time. Pronostic variables included in the study are clinical stage, grade of differentiation, presence of ureteral obstruction, chemotherapy modality, radiotherapy doses and p53 and ki-67 expression. RESULTS: Mean and median time are 51 and 39 months in patients with multimodal treatment. Complete response is achieved in 72% of cases treated with bladder preservation. Ureteral obstruction is a prognostic factor (OR: 7,3;p:0,02). 72% patients with complete response mantain it at the end of the study. None of analyzed variables are predictors of maintenance of the response. Survival rates with a intact bladder were 69±7% and 61±7% at three and five years. Radiotherapy doses greater than 60Gy (OR: 6,1; p<0,001) and the absence of ureteral obstruction (OR: 7,5; p<0,002) were pronostic variables. Free-survival in patients with complete response was 80±7% and 58±10% at three and five years. At the end of the study, 53,5% of patients had a intact bladder and free-disease.In the same period of time, 145 radical cistectomies were performed due to muscle invasive bladder cancer. Mean and median time in this group were 29 and 18 months respectively. Stadistical analysis reveals a worse clinical stage in the group of patients treated with multimodal treatment (p:0.01). Free-survival was 72±5% and 63±7% at 3 and 5 years in the group of radical cistectomies. There was not statistical significant differences between cistectomies and bladder preservation. CONCLUSIONS: Patients treated with bladder preservation have a free-survival similar to those treated with radical cistectomy. Radiotherapy doses greater than 60Gy and absence of ureteral obstruction were free-survival prognostic variables.

[Laparoscopic partial nephrectomy. Analysis of first 30 cases of our series and review of the literature]. / Nefrectomía parcial laparoscópica. Análisis de los primeros 30 casos de nuestra serie y revisión de la literatura.

OBJECTIVE: Our goal is to analyze the surgical and clinicopathological results of our first 30 laparoscopic partial nephrectomies (LPN) performed consecutively and correlate the results with the literature. MATERIAL AND METHODS: This is a cases series, with 30 patients (20 men and 10 women) operated between 2006 and 2008. We assessed the clinicopathological factors and complications. The mean and median follow-up was 25 and 5 months. RESULTS: Resected tumors had an average size of 2.4 cm. 60% of the tumors were malignant. The pathological stage was pT1 in 100% of cases (47% grade I, 53% Fuhrman grade II).Surgical margins were positive in 3 cases, switching to open surgery. Intraoperative bleeding was 74.66 cc (35.7±SD) and 70 cc of mean and median. The mean operative time was 214.4min (±69) and ischemia time of 31.3min (±13.8). CONCLUSIONS: Our results are similar to those reported in the literature, except for positive margins and conversion attributable to the learning curve.

Edad del donante y su influencia en la supervivencia del injerto / Influence of donor age on graft survival

Introducción: En 2007 en España el 43% de los donantes tuvo más de 60 años, lo que supone peor calidad del injerto y probablemente peor supervivencia. Objetivo: Nuestro objetivo es analizar la influencia de la edad del donante en la supervivencia del injerto. Material y métodos: Analizamos retrospectivamente 216 trasplantes renales consecutivos realizados entre 2000–2008. Valoramos la influencia de la edad del donante sobre la supervivencia del injerto y buscamos el mejor punto de corte. Para el estudio de la supervivencia actuarial del injerto se ha utilizado el método de Kaplan Meyer. Para la comparación de curvas de supervivencia utilizamos el test de log-rank. Para el estudio de los factores influyentes en la supervivencia hemos utilizado los modelos de regresión de Cox en forma de estudio univariado y multivariado. Resultados: La media de seguimiento fue de 48 meses (±33,4 DE) y la mediana de seguimiento fue de 48 meses (rango de 0–166 meses).El análisis univariado de la supervivencia del injerto nos mostró que la edad del donante como variable continua influye significativamente en la supervivencia del injerto (odds ratio: 1,03; 95% intervalo de confianza [IC]: 1,01–1,05; p=0,009).Al estudiar la relación entre la edad del donante y el receptor evidenciamos una correlación inversa significativa (correlación de Pearson: 0,55; p<0,0001), pero a pesar de esto, la significación se mantiene si se ajusta con la edad de los receptores (odds ratio: 1,02; 95% IC: 1,01–1,04) (p=0,04). El mejor punto de corte corresponde a 60 años. La supervivencia actuarial del injerto en donantes mayores de 60 años es del 79 (95% IC: 74–84) y del 71% (95% IC: 65–77) en 3 y 5 años frente al 94 (95% IC: 94–96%) y al 90% (95% IC: 88–92) en los receptores de riñones de donantes menores de 60 años (p=0,002).El estudio multivariado de los factores influyentes en la supervivencia del injerto revela que la edad del donante dicotomizada en mayor y menor de 60 años, la presencia de reintervenciones quirúrgicas inmediatas y la función diferida eran los factores de influencia independiente en la supervivencia del injerto. Conclusiones: La edad del donante mayor de 60 años influye negativamente en la supervivencia del injerto renal con valor pronóstico independiente (AU)

Introduction: In 2007 in Spain 43% of donors were older than 60 years. This produces a worse graft quality and probably a worse survival. Objective: Our objective is to analyze the influence of donor age on graft survival. Material and methods: We analyze retrospectively 216 renal consecutive transplants realized between 2000 and 2008. A univaried and multivaried study (Cox regression) was performed and Kaplan-Meyer test with log rank for graft survival. Results: Follow-up mean of 40 months (±33,4 SD). The univaried analysis of graft survival showed that donor age had a significative influence on graft survival. (OR=1,03; 95% CI 1,01–1,05) (p: 0,009). Studying the relation between donor and recipient age we find an inverse correlation (Pearson's Correlation: 0,55. p<0,0001), but there are significative differences after the adjustment for recipient age. (OR: 1,02; 95% CI 1,01–1,04) (p: 0,04). Optimal cut-point value determined by the ROC analysis was 60 years. The graft survival of donors over 60 years is 79% (95% CI; 74–84%) and 71%(95% CI; 65–77%) at 3 and 5 years in contrast with 94% (95% CI; 94–96%) and 90% (95% CI; 88–92 in donors under 60. (p: 0,002). The multivaried study of the influential factors on graft survival reveals that donor age dichotomized in older or younger than 60, the presence of a surgical immediate reintervention and a delayed graft function were independent influence factors. Conclusions: Donor age over 60 years has a negative and independent prognostic influence on graft survival (AU)

[Influence of donor age on graft survival]. / Edad del donante y su influencia en la supervivencia del injerto.

INTRODUCTION: In 2007 in Spain 43% of donors were older than 60 years. This produces a worse graft quality and probably a worse survival. OBJECTIVE: Our objective is to analyze the influence of donor age on graft survival. MATERIAL AND METHODS: We analyze retrospectively 216 renal consecutive transplants realized between 2000 and 2008. A univaried and multivaried study (Cox regression) was performed and Kaplan-Meyer test with log rank for graft survival. RESULTS: Follow-up mean of 40 months (+/-33,4 SD). The univaried analysis of graft survival showed that donor age had a significative influence on graft survival. (OR=1,03; 95% CI 1,01-1,05) (p: 0,009). Studying the relation between donor and recipient age we find an inverse correlation (Pearson's Correlation: 0,55. p<0,0001), but there are significative differences after the adjustment for recipient age. (OR: 1,02; 95% CI 1,01-1,04) (p: 0,04). Optimal cut-point value determined by the ROC analysis was 60 years. The graft survival of donors over 60 years is 79% (95% CI; 74-84%) and 71% (95% CI; 65-77%) at 3 and 5 years in contrast with 94% (95% CI; 94-96%) and 90% (95% CI; 88-92 in donors under 60. (p: 0,002). The multivaried study of the influential factors on graft survival reveals that donor age dichotomized in older or younger than 60, the presence of a surgical immediate reintervention and a delayed graft function were independent influence factors. CONCLUSIONS: Donor age over 60 years has a negative and independent prognostic influence on graft survival.

[Laparoscopic adrenalectomy for metachronous metastasis. Experience in 12 cases]. / Adrenalectomía laparoscópica por metástasis metácrona. Experiencia en 12 casos.

OBJECTIVE: To assess the peroperative and oncological results of laparoscopic adrenalectomy for an isolated metastasis. MATERIAL AND METHODS: A retrospective, descriptive study was conducted of 12 laparoscopic adrenalectomies performed for metastases out of a total of 40 adrenalectomies performed from May 1998 to April 2009. The primary tumor was pulmonary in 7 patients, renal in 3, and colonic in 2. Demographic data collected included median age, operating time, blood loss, complications, tumor size, and length of hospital stay. The Kaplan-Meier method was used to analyze survival. RESULTS: Operating time was 150 min (range, 90-206). Peroperative bleeding was 60 ml (range, 15-150). Peroperative complications occurred in 3% of patients. Tumor size was 4.5 cm (range, 1.3-8.5). No positive margins were seen in the resected specimens. Hospital stay was 3 days (range 3-5). Actuarial survival was 55.6% at 23 months (range, 2-38) with mean and median follow-up times of 20.9 and 23 months. CONCLUSIONS: In selected patients, laparoscopic adrenalectomy for metastasis is a safe procedure with oncological results superimposable to those of open surgery.

[Surgical complications in kidney transplantation and their influence on graft survival]. / Complicaciones quirúrgicas en el trasplante renal y su influencia en la supervivencia del injerto.

OBJECTIVES: To analyze surgical complications in kidney transplantation and their influence on graft survival. MATERIALS AND METHODS: A retrospective analysis was made of the early and late surgical complications occurring in 216 consecutive kidney transplants performed at our institution and their influence on graft survival. RESULTS: At least one surgical complication occurred in 82 (38%) of the 216 transplantations, and 68 (31%) required some type of repeat surgery, 23 in the early postoperative period and 45 more than 3 months after surgery. Mean follow-up was 48 months (SD +/-33.4), and median follow-up 48 months (range, 0-166 months). No recipient or donor factors predisposing to surgical complications were found. Graft survival was significantly shorter in patients with surgical complications [3- and 5-year survival rates of 86% (95% CI 83-89) and 78% (95% CI 73-82) as compared to 92% (95% CI 90-94) and 88% (95% CI 85-91), p=0.004]. Early repeat surgery, venous thrombosis, and wound infection were among the complications having an independent influence on graft survival. A multivariate analysis of graft survival in the whole group showed early repeat surgery to be a factor with an independent prognostic value (OR: 4.7; 95% CI 2.2-10, p<0.0001). Delayed function and donor age older than 60 years were the other independent influential factors. CONCLUSION Surgical complications have an influence on graft survival. The need for early repeat surgery, delayed function, and donor age older than 60 years are independent predictors of graft survival.

Complicaciones quirúrgicas en el trasplante renal y su influencia en la supervivencia del injerto / Surgical complications in kidney transplantation and their influence on graft survival

Objetivo: Nuestro objetivo es analizar las complicaciones quirúrgicas en el trasplante renal y su influencia en la supervivencia del injerto. Material y métodos: Analizamos retrospectivamente 216 trasplantes renales realizados entre el 1 de enero de 2000 y el 31 de diciembre de 2008, analizando las complicaciones quirúrgicas y valorando su influencia sobre la supervivencia del injerto renal. Resultados: De los 216 trasplantes, 82 (38%) tuvieron algún tipo de complicación quirúrgica y 68 (31%) requirieron algún tipo de reintervención (23 en postoperatorio inmediato y 45 más allá de los 3 meses). Media de seguimiento de 48 meses (+/−33,4 desviación estándar) y mediana de seguimiento de 48 meses (rango de 0 a 166).No se han objetivado en receptor o donante factores que predispongan a la incidencia de complicaciones. La supervivencia del injerto es significativamente menor en los pacientes con complicaciones quirúrgicas (supervivencia a los 3 y a los 5 años del 86% [intervalo de confianza {IC} 95%: 83–89] y del 78%% [IC 95%: 73–82] vs. el 92% [IC 95%: 90–94] y el 88%% [IC 95%: 85–91]; p=0,004). La reintervención precoz, la trombosis venosa y la infección de herida son las complicaciones que tienen influencia independiente en la supervivencia. El estudio multivariado de la supervivencia del injerto de todo el grupo pone de manifiesto que la reintervención precoz es un factor de influencia independiente (odds ratio: 4,7; IC 95%: 2,2–10; p<0,0001). La función diferida y la edad del donante mayor de 60 años son los otros factores influyentes. Conclusiones: Las complicaciones quirúrgicas influyen en la supervivencia del injerto. La necesidad de cirugía precoz es una variable con valor pronóstico independiente sobre supervivencia del injerto junto con la función diferida y la edad del donante (AU)

Objectives: To analyze surgical complications in kidney transplantation and their influence on graft survival. Materials and methods: A retrospective analysis was made of the early and late surgical complications occurring in 216 consecutive kidney transplants performed at our institution and their influence on graft survival. Results: At least one surgical complication occurred in 82 (38%) of the 216 transplantations, and 68 (31%) required some type of repeat surgery, 23 in the early postoperative period and 45 more than 3 months after surgery. Mean follow–up was 48 months (SD +/−33.4), and median follow–up 48 months (range, 0–166 months).No recipient or donor factors predisposing to surgical complications were found. Graft survival was significantly shorter in patients with surgical complications [3- and 5-year survival rates of 86% (95% CI 83-89 %) and 78% (95% CI 73-82%) as compared to 92% (95% CI 90-94%) and 88% (95% CI 85-91%), p:0.004]. Early repeat surgery, venous thrombosis, and wound infection were among the complications having an independent influence on graft survival. A multivariate analysis of graft survival in the whole group showed early repeat surgery to be a factor with an independent prognostic value (OR: 4.7; 95% CI 2.2–10, p<0.0001). Delayed function and donor age older than 60 years were the other independent influential factors. Conclusion: Surgical complications have an influence on graft survival. The need for early repeat surgery, delayed function, and donor age older than 60 years are independent predictors of graft survival (AU)

Adrenalectomía laparoscópica por metástasis metácrona. Experiencia en 12 casos / Laparoscopic adrenalectomy for metachronous metastasis. Experience in 12 cases

Objetivos: evaluar los resultados perioperatorios y oncológicos de la adrenalectomía laparoscópica por metástasis aislada. Material y métodos: estudio retrospectivo y descriptivo de 12 adrenalectomías laparoscópicas por metástasis de un total de 40 realizadas entre mayo de 1998 y abril de 2009. El tumor primario fue en siete casos de pulmón, en tres renal y en dos de colon. Los datos demográficos de la serie incluyeron edad, tiempo operatorio, sangrado, complicaciones, tamaño tumoral y estancia hospitalaria expresados como mediana. El análisis de supervivencia se hizo con el método de Kaplan-Meier. Resultados: el tiempo operatorio fue de 150 minutos (rango 90 a 206). El sangrado intraoperatorio fue de 60 cc (rango 15 a 150). Hubo complicaciones intraoperatorias en el 3% de los casos. El tamaño tumoral fue de 4,5 cm (rango 1,3 a 8,5). No se observaron márgenes positivos en las piezas de resección. La estancia hospitalaria fue de tres días (rango 3 a 5). La supervivencia actuarial fue del 55,6% a los 23 meses (rango 2 a 38), con una media y mediana de seguimiento de 20,9 y 23 meses, respectivamente. Conclusiones: la adrenalectomía laparoscópica por metástasis en pacientes seleccionados e suna técnica segura con resultados oncológicos superponibles a los de la cirugía abierta (AU)

Objective: To assess the peroperative and oncological results of laparoscopic adrenalectomy for an isolated metastasis. Material and methods: A retrospective, descriptive study was conducted of 12 laparoscopic adrenalectomies performed for metastases out of a total of 40 adrenalectomies performed from May 1998 to April 2009. The primary tumor was pulmonary in 7 patients, renal in 3, and colonic in 2. Demographic data collected included median age, operating time, blood loss, complications, tumor size, and length of hospital stay. The Kaplan-Meier method was used to analyze survival. Results: Operating time was 150 min (range, 90-206). Peroperative bleeding was 60 ml (range, 15-150). Peroperative complications occurred in 3% of patients. Tumor size was 4.5cm (range, 1.3-8.5). No positive margins were seen in the resected specimens. Hospital stay was 3 days (range 3-5). Actuarial survival was 55.6% at 23 months (range, 2-38) with mean and median follow-up times of 20.9 and 23 months. Conclusions: In selected patients, laparoscopic adrenalectomy for metastasis is a safe procedure with oncological results superimposable to those of open surgery (AU)

[Pelvic lymph node dissection (extended vs standard) and prostate cancer]. / Linfadenectomía (ampliada vs estándar) y cáncer de próstata.

The role and the potential benefit, if any, of pelvic lymphadenectomy in prostate cancer are still controversially discussed. It is generally accepted that PLND at time of radical prostatectomy is the only reliable diagnostic procedure to achieve as much individual histological staging information as possible to trigger postoperative adjuvant management. However, the extent of pelvic lymph node dissection (limited vs. extended) and the most suitable candidates for this procedure are still a matter of intense debate. The aim of this review is to critically evaluate the current status on lymph node dissection in prostate cancer.

Linfadenectomía (ampliada vs estándar) y cáncer de próstata / Pelvic lymph node dissection (extended vs standard) and prostate cancer

El papel y el beneficio potencial de la linfadenectomía en el cáncer de próstata sigue siendo motivo de controversia. Generalmente se acepta que la linfadenectomía en el momento de realizarse la prostatectomía radical es el único procedimiento diagnóstico que nos acerca a un estadiaje anatomopatológico más preciso permitiéndonos un mejor manejo postoperatorio. Sin embargo la extensión de la disección linfática (limitada vs extensa) y los candidatos más adecuados para estos procedimientos sigue siendo motivo de intenso debate. El propósito de este artículo de revisión es una evaluación crítica del papel actual de la disección linfática en el cáncer de próstata (AU)

The role and the potential benefit, if any, of pelvic lymphadenectomy in prostate cancer are still controversially discussed. It is generally accepted that PLND at time of radical prostatectomy is the only reliable diagnostic procedure to achieve as much individual histological staging information as possible to trigger postoperative adjuvant management. However, the extent of pelvic lymph node dissection (limited vs. extended) and the most suitable candidates for this procedure are still a matter of intense debate. The aim of this review is to critically evaluate the current status on lymph node dissection in prostate cancer (AU)